Provider Demographics
NPI:1457378044
Name:WILKINSON, ROBERT M (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064-7904
Mailing Address - Country:US
Mailing Address - Phone:270-965-5743
Mailing Address - Fax:
Practice Address - Street 1:141 HOSPITAL DR STE 103
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-8043
Practice Address - Country:US
Practice Address - Phone:270-988-3298
Practice Address - Fax:270-988-4642
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP085181363L00000X
IL041-306933363L00000X
IN71003857A363L00000X
KY3002333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000797909OtherBCBS-BAPTIST HEALTH
KY000000534179OtherBCBS PROVIDER NUMBER
KY78005048Medicaid
KYP01172285OtherRAILROD MEDICARE - PALMETTO GBA
KY78005048Medicaid
KYK030464Medicare PIN
KY000000534179OtherBCBS PROVIDER NUMBER
ILK49918Medicare PIN
KY000000797909OtherBCBS-BAPTIST HEALTH
KY00280022Medicare PIN
KYK030463Medicare PIN